Fatal septic shock due to PVL-positive Staphylococcus aureus necrotizing pneumonia: autopsy findings and systematic review of the literature

Panton–Valentine leukocidin (PVL)–producing Staphylococcus aureus is associated with highly aggressive necrotizing pneumonia characterized by rapid clinical deterioration and high mortality. However, the clinicopathological features of fatal cases, particularly in the forensic setting, remain incompletely defined. We report a fatal case of PVL-positive S. aureus necrotizing pneumonia diagnosed through forensic autopsy and molecular analysis. In addition, a systematic review was conducted according to PRISMA 2020 guidelines. PubMed/MEDLINE and Scopus were searched from database inception to 12 March 2026 to identify published fatal cases of PVL-positive S. aureus pneumonia. A previously healthy 58-year-old man presented with acute respiratory symptoms and rapidly developed severe respiratory failure and septic shock, resulting in death within 24 h of hospital admission. Blood cultures and bronchoalveolar lavage yielded methicillin-susceptible S. aureus . Autopsy revealed bilateral necrotizing hemorrhagic bronchopneumonia, and molecular analysis confirmed PVL positivity. The literature review identified 31 fatal cases. Most cases were characterized by rapid clinical deterioration, frequent septic shock, and hemoptysis or pulmonary hemorrhage. When autopsy was performed, a consistent pattern of necrotizing and hemorrhagic pulmonary infection was observed. PVL-positive S. aureus pneumonia represents a rare but highly aggressive infection that may rapidly progress to respiratory failure and death. The combination of rapid clinical deterioration, hemoptysis, and necrotizing hemorrhagic pneumonia at autopsy represents a distinctive clinicopathological pattern. Integration of autopsy findings with microbiological and molecular investigations is essential for establishing the diagnosis in rapidly fatal infectious deaths.